Co-occurring Fatigue and Lymphatic Pain Incrementally Aggravate Their Negative Effects on Activities of Daily Living, Emotional Distress, and Overall Health of Breast Cancer Patients

Abstract

Background: Fatigue and lymphatic pain are the most common and debilitating long-term adverse effects of breast cancer treatment. Fatigue and pain independently have negative effects on quality of life, physical functions, and cancer recurrence-free survival. The interactions between fatigue and pain may aggravate their negative effects. Objectives: Examine the effects of co-occurring fatigue and lymphatic pain on activities of daily living (ADLs), emotional distress, and overall health of breast cancer patients. Methods: A cross-sectional and observational design was used to enroll 354 breast cancer patients. Valid and reliable instruments were used to assess fatigue, lymphatic pain, ADLs, emotional distress, and overall health. Descriptive statistics and multivariable regression models were used for data analysis. Results: After controlling for demographic and clinical factors, patients with co-occurring fatigue and lymphatic pain had higher odds of having impaired ADLs (OR = 24.43, CI = [5.44-109.67], P < .001) and emotional distress (OR = 26.52, CI = [9.64-72.90], P < .001) compared to patients with only fatigue and only lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had 179% increase in impaired ADL scores ( B = 8.06, CI = [5.54-10.59]) and 211% increase in emotional distress scores ( B = 9.17, CI = [5.52-12.83]) compared to those without co-occurring fatigue and lymphatic pain. Patients with co-occurring fatigue and lymphatic pain had a 34% decrease ( B = −26.29, CI = [−31.90 to −20.69]) and patients with only fatigue had a 33% decrease in overall health scores ( B = −25.74, 95% CI = [−34.14 to −17.33]), indicating poor overall health. Conclusions: Fatigue and lymphatic pain affected 66.4% of breast cancer patients. Findings from this study suggest that co-occurring fatigue and lymphatic pain have negative effects on breast cancer patients’ ADLs, emotional distress, and overall health. The synergistic interactions between fatigue and lymphatic pain incrementally aggravated their negative effects on ADLs and emotional distress. Findings of the study highlight the need to evaluate the underlying mechanisms for co-occurring fatigue and lymphatic pain and develop interventions that target both fatigue and lymphatic pain to improve breast cancer patients’ the quality of life.

Prognostic Factors and Outcomes Associated With Neck Lymphedema in Head and Neck Cancer Survivors

“…31 Other studies in breast cancer literature have also found that the stage of tumor was significantly associated with lymphedema development. 32 In the context of HNC, lymph node involvement can indicate that the cancer has affected the regional lymphatic system. Lymph nodes compromised by cancer or cancer treatment may lead to reduced lymphatic function, exacerbating the risk of lymphedema.…”

“…Consistent with our findings, a previous study in breast cancer patients also found that while BMI was associated with breast cancer lymphedema, the effects of comorbidities such as age, hypertension, diabetes, and smoking as risk factors in lymphedema were minimal. 32 Deng et al conducted a study in 2012 that systematically examined associations between lymphedema and various prognostic factors in HNC patients and similarly did not find that any demographic factors, comorbidities, or health-related behaviors were correlated with lymphedema. 13 Deng speculated that tumor and treatment-related effects may overshadow the role of demographics or comorbidities in lymphedema manifestation.…”

“…Studies in both breast cancer and HNC literature have found that lymphedema is correlated with fatigue. 32,33 While underlying mechanisms linking fatigue to lymphedema are still unclear, the chronic inflammatory state associated with lymphedema, altered immune responses, functional limitations, and psychosocial impact of lymphedema may contribute to the experience of fatigue. Further research needs to be done to understand underlying causes and explore effective interventions to address such symptoms.…”

“…However, one study conducted on breast cancer patients did find that N stage was a positive predictor, speculating that the advanced disease stage is correlated with lymphedema 31 . Other studies in breast cancer literature have also found that the stage of tumor was significantly associated with lymphedema development 32 . In the context of HNC, lymph node involvement can indicate that the cancer has affected the regional lymphatic system.…”

Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients with End-Stage Renal Disease

“…The Activities of Daily Living (ADL) scale was used to evaluate the functional status of the participants. A score of less than 5/6 indicated that the patient was functionally impaired or dependent on others [ 17 ].…”